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Darkness Visible: 
A Memoir Of Madness 

William Styron 


Lie Down in Darkness 

The Long March 

Set This House on Fire 

The Confessions of Nat Turner 

Sophie's Choice 

This Quiet Dust 

To Rose 


This book began as a lecture given in Baltimore in May 1989 at a 
symposium on affective disorders sponsored by the Department of 
Psychiatry of The Johns Hopkins University School of Medicine. Greatly 
expanded, the text became an essay published in December of that year 
in Vanity Fair, I had originally intended to begin with a narrative of 
a trip I made to Paris- -a trip which had special significance for me in 
terms of the development of the depressive illness from which I had 
suffered. But despite the exceptionally ample amount of space I was 
given by the magazine, there was an inevitable limit, and I had to 
discard this part in favor of other matters I wanted to deal with. In 
the present version, that section has been restored to its place at the 
beginning. Except for a few relatively minor changes and additions, 
the rest of the text remains as it originally appeared. 

--W. s. 

For the thing which 

I greatly feared is come upon me, 

and that which I was afraid of 

Is come unto me. 

I was not in safety, neither had I rest, neither was I quiet; 

yet trouble came. 


aware that the struggle with the disorder in my mind--a struggle which had 
engaged me for several months--might have a fatal outcome. 

The moment of revelation came as the car in which I was riding moved 
down a rain-slick street not far from the Champs-filysees and slid past 
a dully glowing neon sign that read HOTEL WASHINGTON. I had not seen 
that hotel in nearly thirty-five years, since the spring of 1952, when 
for several nights it had become my initial Parisian roosting place. In 
the first few months of my Wanderjahr, I had come down to Paris by 
train from Copenhagen, and landed at the Hotel Washington through the 
whimsical determination of a New York travel agent. In those days the 
hotel was one of the many damp, plain hostelries made for tourists, 
chiefly American, of very modest means who, if they were like 
me- -colliding nervously for the first time with the 

French and their droll kinks would always remember how the exotic 
bidet, positioned solidly in the drab bedroom, along with the toilet 
far down the ill-lit hallway, virtually defined the chasm between 
Gallic and Anglo-Saxon cultures. But I stayed at the Washington for 
only a short time. Within days I had been urged out of the place by 
some newly found young American friends who got me installed in an even 
seedier but more colorful hotel in Montparnasse, hard by Le Dome and 
other suitably literary hangouts. (In my mid-twenties, I had just 
published a first novel and was a celebrity, though one of very low 
rank since few of the Americans in Paris had heard of my book, let 
alone read it.) And over the years the Hotel Washington gradually 
disappeared from my consciousness. 

It reappeared, however, that October night when I passed the gray stone 
facade in a drizzle, and the recollection of my arrival so many years 
before started flooding back, causing me to feel that I had come 
fatally full circle. I recall saying to myself that when I left Paris 
for New York the next morning it would be a matter of forever. I was 
shaken by the certainty with which I accepted the idea that I would 

never see France again, just as I would never recapture a lucidity that 
was slipping away from me with terrifying speed. 

Only days before I had concluded that I was suffering from a serious 
depressive illness, and was floundering helplessly in my efforts to 
deal with it. I wasn't cheered by the festive occasion that had 
brought me to France. Of the many dreadful manifestations of the 
disease, both physical and psychological, a sense of self-hatred or, 
put less categorically, a failure of selfesteem is one of the most 
universally experienced symptoms, and I had suffered more and more from 
a general feeling of worthlessness as the malady had progressed. 

My dank joylessness was therefore all the more ironic because I had 
flown on a rushed four-day trip to Paris in order to accept an award 
which should have sparklingly restored my ego. Earlier that summer I 
received word that I had been chosen to receive the Prix Mondial Cino 
del Duca, given annually to an artist or scientist whose work reflects 
themes or principles of a certain "humanism." The prize was 
established in memory of Cino del Duca, an immigrant from Italy who 
amassed a fortune just before and after World War II by printing and 
distributing cheap magazines, principally comic books, though later 
branching out into publications of quality; he became proprietor of the 
newspaper Paris- Jour. He also produced movies and was a prominent 
racehorse owner, enjoying the pleasure of having many winners in France 
and abroad. Aiming for nobler cultural satisfactions, he evolved into a 
renowned philanthropist and along the way established a book-publishing 
firm that began to produce works of literary merit (by chance, my first 
novel, Lie Down in Darkness, was one of del Duca's offerings, in a 
translation entitled Un Lit de Tenebres}; by the time of his death in 
1967 this house, Editions Month ales, became an important entity of a 
multifold empire that was rich yet prestigious enough for there to be 
scant memory of its comic-book origins when del Duca's widow, Simone, 
created a foundation whose chief function was the annual bestowal of 
the eponymous award. 

The Prix Mondial Cino del Duca has become greatly respected in 
France--a nation pleasantly besotted with cultural prize giving--not 

only for its eclecticism and the distinction shown in the choice of its 
recipients but for the openhandedness of the prize itself, which that 
year amounted to approximately $25,000. Among the winners during the 
past twenty years have been Kon rad Lorenz, Alejo Carpentier, Jean 
Anouilh, Ignazio Silone, Andrei Sakharov, Jorge Luis Borges and one 
American, Lewis Mumford. (No women as yet, feminists take note.) As an 
American, I found it especially hard not to feel honored by inclusion 
in their company. 

While the giving and receiving of prizes usually induce from all 
sources an unhealthy uprising of false modesty, backbiting, 
self-torture and envy, my own view is that certain awards, though not 
necessary, can be very nice to receive. The Prix del Duca was to me so 
straightforwardly nice that any extensive self examination seemed 
silly, and so I accepted gratefully, writing in reply that I would 
honor the reasonable requirement that I be present for the ceremony. At 
that time I looked forward to a leisurely trip, not a hasty turnaround. 
Had I been able to foresee my state of mind as the date of the award 
approached, I would not have accepted at all. 

Depression is a disorder of mood, so mysteriously painful and elusive 
in the way it becomes known to the self- -to the mediating intellect- -as 
to verge close to being beyond description. It thus remains nearly 
incomprehensible to those who have not experienced it in its extreme 
mode, although the gloom, "the blues" which people go through 
occasionally and associate with the general hassle of everyday 
existence are of such prevalence that they do give many individuals a 
hint of the illness in its catastrophic form. But at the time of which 
I write I had descended far past those familiar, manageable doldrums. 
In Paris, I am able to see now, I was at a critical stage in the development 
of the disease, situated at an ominous way station between its unfocused 
stirrings earlier that summer and the near-violent denouement of December, 
which sent me into the hospital. I will later attempt to describe the 
evolution of this malady, from its earliest origins to my eventual 
hospitalization and recovery, but the Paris trip has retained a notable 
meaning for me. 

On the day of the award ceremony, which was to take place at noon and 
be followed by a formal luncheon, I woke up at midmorning in my room at 
the Hotel Pont-Royal commenting to myself that I felt reasonably sound, 
and I passed the good word along to my wife, Rose. Aided by the minor 
tranquilizer Halcion, I had managed to defeat my insomnia and get a few 
hours' sleep. Thus I was in fair spirits. But such wan cheer was an 
habitual pretense which I knew meant very little, for I was certain to 
feel ghastly before nightfall. I had come to a point where I was 
carefully monitoring each phase of my deteriorating condition. My 
acceptance of the illness followed several months of denial during 
which, at first, I had ascribed the malaise and restlessness and sudden 
fits of anxiety to withdrawal from alcohol; I had abruptly abandoned 
whiskey and all other intoxicants that June. 

During the course of my worsening emotional climate I had read a 
certain amount on the subject of depression, both in books tailored for 
the layman and in weightier professional works including the 
psychiatrists' bible, DSM (The Diagnostic and Statistical Manual of the 
American Psychiatric Association}. Throughout much of my life I have 
been compelled, perhaps unwisely, to become an autodidact in medicine, 
and have accumulated a better-than-average amateur's knowledge about 
medical matters (to which many of my friends, surely unwisely, have 
often deferred), and so it came as an astonishment to me that I was 
close to a total ignoramus about depression, which can be as serious a 
medical affair as diabetes or cancer. Most likely, as an incipient 
depressive, I had always subconsciously rejected or ignored the proper 
knowledge; it cut too close to the psychic bone, and I shoved it aside 
as an unwelcome addition to my store of information. 

At any rate, during the few hours when the depressive state itself 
eased off long enough to permit the luxury of concentration, I had 
recently filled this vacuum with fairly extensive reading and I had 
absorbed many fascinating and troubling facts, which, however, I could 
not put to practical use. The most honest authorities face up squarely 
to the fact that serious depression is not readily treatable. Unlike, 
let us say, diabetes, where immediate measures taken to rearrange the 
body's adaptation to glucose can dramatically reverse a dangerous 

process and bring it under control, depression in its major stages 
possesses no quickly available remedy: failure of alleviation is one of 
the most distressing factors of the disorder as it reveals itself to 
the victim, and one that helps situate it squarely in the category of 
grave diseases. Except in those maladies strictly designated as 
malignant or degenerative, we expect some kind of treatment and 
eventual amelioration, by pills or physical therapy or diet or surgery, 
with a logical progression from the initial relief of symptoms to final 
cure. Frighteningly, the layman-sufferer from major depression, taking 
a peek into some of the many books currently on the market, will find 
much in the way of theory and symptomatology and very little that 
legitimately suggests the possibility of quick rescue. Those that do 
claim an easy way out are glib and most likely fraudulent. There are 
decent popular works which intelligently point the way toward treatment 
and cure, demonstrating how certain therapies--psychotherapy or 
pharmacology, or a combination of these- -can indeed restore people to 
health in all but the most persistent and devastating cases; but the wisest 
books among them underscore the hard truth that serious depressions do not 
disappear overnight. All of this emphasizes an essential though difficult 
reality which I think needs stating at the outset of my own chronicle: the 
disease of depression remains a great mystery. It has yielded its secrets 
to science far more reluctantly than many of the other major ills besetting 
us. The intense and sometimes comically strident factionalism that exists 
in present day psychiatry- -the schism between the believers in psychotherapy 
and the adherents of pharmacology-resembles the medical quarrels of the 
eighteenth century (to bleed or not to bleed) and almost defines in itself 
the inexplicable nature of depression and the difficulty of its treatment. 
As a clinician in the field told me honestly and, I think, with a striking 
deftness of analogy: "If you compare our knowledge with Colum bus ' s discovery 
of America, America is yet unknown; we are still down on that little island 
in the Bahamas. " 

In my reading I had learned, for example, that in at least one interesting 
respect my own case was atypical. 

Most people who begin to suffer from the illness are laid low in the 
morning, with such malefic effect that they are unable to get out of 
bed. They feel better only as the day wears on. But my situation was 

just the reverse. While I was able to rise and function almost normally 
during the earlier part of the day, I began to sense the onset of the symptoms 
at midafternoon or a little later- -gloom crowding in on me, a sense of 
dread and alienation and, above all, stifling anxiety. I suspect that 
it is basically a matter of indifference whether one suffers the most 
in the morning or the evening: if these states of excruciating 
near-paralysis are similar, as they probably are, the question of 
timing would seem to be academic. But it was no doubt the turnabout of 
the usual daily onset of symptoms that allowed me that morning in Paris 
to proceed without mishap, feeling more or less self-possessed, to the 
gloriously ornate palace on the Right Bank that houses the Fondation 
Cino del Duca. There, in a rococo salon, I was presented with the 
award before a small crowd of French cultural figures, and made my 
speech of acceptance with what I felt was passable aplomb, stating that 
while I was donating the bulk of my prize money to various 
organizations fostering French American goodwill, including the 
American Hospital in Neuilly, there was a limit to altruism (this 
spoken jokingly) and so I hoped it would not be taken amiss if I held 
back a small portion for myself. 

What I did not say, and which was no joke, was that the amount I was withholding 
was to pay for two tickets the next day on the Concorde, so that I might 
return speedily with Rose to the United States, where just a few days before 
I had made an appointment to see a psychiatrist. For reasons that I'm sure 
had to do with a reluctance to accept the reality that my mind was dissolving, 
I had avoided seeking psychiatric aid during the past weeks, as my distress 
intensified. But I knew I couldn't delay the confrontation indefinitely, 
and when I did finally make contact by telephone with a highly recommended 
therapist, he encouraged me to make the Paris trip, telling me that he would 
see me as soon as I returned. I very much needed to get back, and fast. 
Despite the evidence that I was in serious difficulty, I wanted to maintain 
the rosy view. A lot of the literature available concerning depression is, 
as I say, breezily optimistic, spreading assurances that nearly all 
depressive states will be stabilized or reversed if only the suitable 
antidepressant can be found; the reader is of course easily swayed by 
promises of quick remedy. In Paris, even as I delivered my remarks, I had 
a need for the day to be over, felt a consuming urgency to fly to America 
and the office of the doctor, who would whisk my malaise away with his 

miraculous medications. I recollect that moment clearly now, and am hardly 
able to believe that I possessed such ingenuous hope, or that I could have 
been so unaware of the trouble and peril that lay ahead. 

Simone del Duca, a large dark-haired woman of queenly manner, was 
understandably incredulous at first, and then enraged, when after the 
presentation ceremony I told her that I could not join her at lunch 
upstairs in the great mansion, along with a dozen or so members of the 
Academic Franchise, who had chosen me for the prize. My refusal was 
both emphatic and simpleminded; I told her point-blank that I had 
arranged instead to have lunch at a restaurant with my French 
publisher, Franchise Gallimard. Of course this decision on my part was 
outrageous; it had been announced months before to me and everyone else 
concerned that a luncheon--moreover, a luncheon in my honor--was part 
of the day's pageantry. But my behavior was really the result of the 
illness, which had progressed far enough to produce some of its most 
famous and sinister hallmarks: confusion, failure of mental focus and 
lapse of memory. At a later stage my entire mind would be dominated by 
anarchic disconnections; as I have said, there was now something that 
resembled bifurcation of mood: lucidity of sorts in the early hours of the 
day, gathering murk in the afternoon and evening. It must have been during 
the previous evening's murky distracted ness that I made the luncheon date 
with Franchise Gallimard, forgetting my del Duca obligations. That 
decision continued to completely master my thinking, creating in me such 
obstinate determination that now I was able to blandly insult the worthy 
Simone del Duca. 

"Alors!" she exclaimed to me, and her face flushed angrily as she 
whirled in a stately volte-face, "au . , . re-voir!" Suddenly I was 
flabbergasted, stunned with horror at what I had done. I fantasized a 
table at which sat the hostess and the Academic Franchise, the guest of 
honor at La Coupole. I implored Madame 's assistant, a bespectacled 
woman with a clipboard and an ashen, mortified expression, to try to 
reinstate me: it was all a terrible mistake, a mixup, a malentendu. And 
then I blurted some words that a lifetime of general equilibrium, and a 
smug belief in the impregnability of my psychic health, had prevented 
me from believing I could ever utter; I was chilled as I heard myself 
speak them to this perfect stranger. 

"I'm sick," I said, "unproblemepsychiatrique. " Madame del Duca was 
magnanimous in accepting my apology and the lunch went off without 
further strain, although I couldn't completely rid myself of the 
suspicion, as we chatted somewhat stiffly, that my benefactress was still 
disturbed by my conduct and thought me a weird number. The lunch was a long 
one, and when it was over I felt myself entering the afternoon shadows with 
their encroaching anxiety and dread. A television crew from one of the 
national channels was waiting (I had forgotten about them, too), ready to 
take me to the newly opened Picasso Museum, where I was supposed to be filmed 
looking at the exhibits and exchanging comments with Rose. This turned out 
to be, as I knew it would, not a captivating promenade but a demanding struggle, 
a major ordeal. 

By the time we arrived at the museum, having dealt with heavy traffic, 
it was past four o'clock and my brain had begun to endure its familiar 
siege: panic and dislocation, and a sense that my thought processes 
were being engulfed by a toxic and unnameable tide that obliterated any 
enjoyable response to the living world. This is to say more 
specifically that instead of pleasure- -certainly instead of the 
pleasure I should be having in this sumptuous showcase of bright 
genius-- I was feeling in my mind a sensation close to, but 
indescribably different from, actual pain. This leads me to touch 
again on the elusive nature of such distress. 

That the word "indescribable" should present itself is not fortuitous, 
since it has to be emphasized that if the pain were readily describable 
most of the countless sufferers from this ancient affliction would have 
been able to confidently depict for their friends and loved ones (even their 
physicians) some of the actual dimensions of their torment, and perhaps 
elicit a comprehension that has been generally lacking; such 
incomprehension has usually been due not to a failure of sympathy but 
to the basic inability of healthy people to imagine a form of torment 
so alien to everyday experience. For myself, the pain is most closely 
connected to drowning or suffocation- -but even these images are off the 
mark. William James, who battled depression for many years, gave up 
the search for an adequate portrayal, implying its near-impossibility 
when he wrote in The Varieties of Religious Experience: "It is a 

positive and active anguish, a sort of psychical neuralgia wholly 
unknown to normal life." 

The pain persisted during my museum tour and reached a crescendo in the 
next few hours when, back at the hotel, I fell onto the bed and lay 
gazing at the ceiling, nearly immobilized and in a trance of supreme 
discomfort. Rational thought was usually absent from my mind at such 
times, hence trance. I can think of no more apposite word for this 
state of being, a condition of helpless stupor in which cognition was 
replaced by that "positive and active anguish." And one of the most 
unendurable aspects of such an interlude was the inability to sleep. It 
had been my custom of a near lifetime, like that of vast numbers of people, 
to settle myself into a soothing nap in the late afternoon, but the 
disruption of normal sleep patterns is a notoriously devastating 
feature of depression; to the injurious sleeplessness with which I had 
been afflicted each night was added the insult of this afternoon 
insomnia, diminutive by comparison but all the more horrendous because 
it struck during the hours of the most intense misery. It had become 
clear that I would never be granted even a few minutes' relief from my 
full-time exhaustion. I clearly recall thinking, as I lay there while 
Rose sat nearby reading, that my afternoons and evenings were becoming 
almost measurably worse, and that this episode was the worst to date. 
But I somehow managed to reassemble myself for dinner with- -who 
else?--Franchoise Gallimard, co-victim along with Simone del Duca of 
the frightful lunchtime contretemps. 

The night was blustery and raw, with a chill wet wind blowing down the 
avenues, and when Rose and I met Franchise and her son and a friend at 
La Lorraine, a glittering brasserie not far from L'Etoile, rain was 
descending from the heavens in torrents. Someone in the group, sensing my 
state of mind, apologized for the evil night, but I recall thinking that 
even if this were one of those warmly scented and passionate evenings for 
which Paris is celebrated I would respond like the zombie I had become. 
The weather of depression is unmodulated, its light a brownout. 

And zombie like halfway through the dinner, I lost the del Duca prize 
check for $25,000. Having tucked the check in the inside breast pocket 
of my jacket, I let my hand stray idly to that place and realized that 

it was gone. Did I "intend" to lose the money? Recently I had been 
deeply bothered that I was not deserving of the prize. I believe in 
the reality of the accidents we subconsciously perpetrate on ourselves, 
and so how easy it was for this loss to be not loss but a form of 
repudiation, offshoot of that self-loathing (depression's premier 
badge) by which I was persuaded that I could not be worthy of the 
prize, that I was in fact not worthy of any of the recognition that had 
come my way in the past few years. Whatever the reason for its 
disappearance, the check was gone, and its loss dovetailed well with 
the other failures of the dinner: my failure to have an appetite for 
the grand plateau de fruits de mer placed before me, failure of even 
forced laughter and, at last, virtually total failure of speech. At 
this point the ferocious inwardness of the pain produced an immense 
distraction that prevented my articulating words beyond a hoarse murmur; 
I sensed myself turning walleyed, monosyllabic, and also I sensed my French 
friends becoming uneasily aware of my predicament. It was a scene from 
a bad operetta by now: all of us near the floor, searching for the 
vanished money. Just as I signaled that it was time to go, Franchise's 
son discovered the check, which had somehow slipped out of my pocket 
and fluttered under an adjoining table, and we went forth into the 
rainy night. Then, while I was riding in the car, I thought of Albert 
Camus and Remain Gary. 


When I was a young writer there had been a stage where Camus, almost 
more than any other contemporary literary figure, radically set the 
tone for my own view of life and history. I read his novel The 
Stranger somewhat later than I should have- -I was in my early 
thirties--but after finishing it I received the stab of recognition that 
proceeds from reading the work of a writer who has wedded moral passion 
to a style of great beauty and whose unblinking vision is capable of 
frightening the soul to its marrow. The cosmic loneliness of Meursault, 
the hero of that novel, so haunted me that when I set out to write The 
Confessions of Nat Turner I was impelled to use Camus 's device of having 
the story flow from the point of view of a narrator isolated in his jail 
cell during the hours before his execution. For me there was a spiritual 
connection between Meursault 's frigid solitude and the plight of Nat 

Turner--his rebel predecessor in history by a hundred years- -likewise 
condemned and abandoned by man and God. Camus' s essay "Reflections on the 
Guillotine" is a virtually unique document, freighted with terrible and 
fiery logic; it is difficult to conceive of the most vengeful supporter 
of the death penalty retaining the same attitude after exposure to 
scathing truths expressed with such ardor and precision. I know my 
thinking was forever altered by that work, not only turning me around 
completely, convincing me of the essential barbarism of capital 
punishment, but establishing substantial claims on my conscience in 
regard to matters of responsibility at large. Camus was a great 
cleanser of my intellect, ridding me of countless sluggish ideas, and through 
some of the most unsettling pessimism I had ever encountered causing me 
to be aroused anew by life's enigmatic promise. 

The disappointment I always felt at never meeting Camus was compounded 
by that failure having been such a near miss. I had planned to see him 
in 1960, when I was traveling to France and had been told in a letter 
by the writer Romain Gary that he was going to arrange a dinner in 
Paris where I would meet Camus. 

The enormously gifted Gary, whom I knew slightly at the time and who 
later became a cherished friend, had informed me that Camus, whom he 
saw frequently, had read my Un Lit de Tmebres and had admired it; I was 
of course greatly flattered and felt that a get together would be a 
splendid happening. But before I arrived in France there came the 
appalling news: Camus had been in an automobile crash, and was dead at 
the cruelly young age of forty-six. I have almost never felt so 
intensely the loss of someone I didn't know. I pondered his death 
endlessly. Although Camus had not been driving he supposedly knew the 
driver, who was the son of his publisher, to be a speed demon; so there 
was an element of recklessness in the accident that bore overtones of 
the near-suicidal, at least of a death flirtation, and it was 
inevitable that conjectures concerning the event should revert back to the 
theme of suicide in the writer's work. One of the century's most famous 
intellectual pronouncements comes at the beginning of The Myth of Sisyphus: 
"There is but one truly serious philosophical problem, and that is suicide. 

Judging whether life is or is not worth living amounts to answering the 

fundamental question of philosophy." Reading this for the first time I 
was puzzled and continued to be throughout much of the essay, since 
despite the work's persuasive logic and eloquence there was a lot that 
eluded me, and I always came back to grapple vainly with the initial 
hypothesis, unable to deal with the premise that anyone should come 
close to wishing to kill himself in the first place. 

A later short novel, The Fall, I admired with reservations; the guilt and 
self-condemnation of the lawyer narrator, gloomily spinning out his 
monologue in an Amsterdam bar, seemed a touch clamorous and excessive, but 
at the time of my reading I was unable to perceive that the lawyer was behaving 
very much like a man in the throes of clinical depression. Such was my 
innocence of the very existence of this disease. 

Camus, Remain told me, occasionally hinted at his own deep despondency 
and had spoken of suicide. 

Sometimes he spoke in jest, but the jest had the quality of sour wine, 
upsetting Romain. Yet apparently he made no attempts and so perhaps it was 
not coincidental that, despite its abiding tone of melancholy, a sense of 
the triumph of life over death is at the core of The Myth of Sisyphus with 
its austere message: in the absence of hope we must still struggle to survive, 
and so we do- -by the skin of our teeth. It was only after the passing of 
some years that it seemed credible to me that Camus ' s statement about suicide, 
and his general preoccupation with the subject, might have sprung at least 
as strongly from some persistent disturbance of mood as from his concerns 
with ethics and epistemology . Gary again discussed at length his 
assumptions about Camus' s depression during August of 1978, when I had 
lent him my guest cottage in Connecticut, and I came down from my 
summer home on Martha's Vineyard to pay him a weekend visit. As we 
talked I felt that some of Romain 's suppositions about the seriousness 
of Camus 's recurring despair gained weight from the fact that he, too, 
had begun to suffer from depression, and he freely admitted as much. It 
was not incapacitating, he insisted, and he had it under control, but 
he felt it from time to time, this leaden and poisonous mood the color 
of verdigris, so incongruous in the midst of the lush New England 
summer. A Russian Jew born in Lithuania, Remain had always seemed possessed 
of an Eastern European melancholy, so it was hard to tell the difference. 

Nonetheless, he was hurting. He said that he was able to perceive a 
flicker of the desperate state of mind which had been described to him 
by Camus. 

Gary's situation was hardly lightened by the presence of Jean Seberg, 
his Iowa-born actress wife, from whom he had been divorced and, I 
thought, long estranged. 

I learned that she was there because their son, Diego, was at a nearby 
tennis camp. Their presumed estrangement made me surprised to see her 
living with Remain, surprised too- -no, shocked and saddened-by her 
appearance: all her once fragile and luminous blond beauty had 
disappeared into a puffy mask. She moved like a sleepwalker, said 
little, and had the blank gaze of someone tranquilized (or drugged, or 
both) nearly to the point of catalepsy. I understood how devoted they 
still were, and was touched by his solicitude, both tender and 
paternal. Romain told me that Jean was being treated for the disorder 
that afflicted him, and mentioned something about antidepressant 
medications, but none of this registered very strongly, and also meant 
little. This memory of my relative indifference is important because 
such indifference demonstrates powerfully the outsider ' s inability to grasp 
the essence of the illness. Camus' s depression and now Romain Gary's- -and 
certainly Jean's- -were abstract ailments to me, in spite of my 
sympathy, and I hadn't an inkling of its true contours or the nature of 
the pain so many victims experience as the mind continues in its 
insidious meltdown. 

In Paris that October night I knew that I, too, was in the process of 
meltdown. And on the way to the hotel in the car I had a clear 
revelation. A disruption of the circadian cycle- -the metabolic and 
glandular rhythms that are central to our workaday life- -seems to be 
involved in many, if not most, cases of depression; this is why brutal 
insomnia so often occurs and is most likely why each day ' s pattern of distress 
exhibits fairly predictable alternating periods of intensity and relief. 
The evening's relief for me-an incomplete but noticeable letup, like the 
change from a torrential downpour to a steady shower--came in the hours 
after dinnertime and before midnight, when the pain lifted a little and 
my mind would become lucid enough to focus on matters beyond the immediate 

upheaval convulsing my system. Naturally I looked forward to this period, 
for sometimes I felt close to being reasonably sane, and that night in the 
car I was aware of a semblance of clarity returning, along with the ability 
to think rational thoughts. Having been able to reminisce about Camus and 
Remain Gary, however, I found that my continuing thoughts were not very 
consoling . 

The memory of Jean Seberg gripped me with sadness. 

A little over a year after our encounter in Connecticut she took an 
overdose of pills and was found dead in a car parked in a cul-de-sac 
off a Paris avenue, where her body had lain for many days. The 
following year I sat with Romain at the Brasserie Lipp during a long 
lunch while he told me that, despite their difficulties, his loss of 
Jean had so deepened his depression that from time to time he had been 
rendered nearly helpless. But even then I was unable to comprehend the 
nature of his anguish. I remembered that his hands trembled and, 
though he could hardly be called superannuated- -he was in his 
mid-sixties- -his voice had the wheezy sound of very old age that I now 
realized was, or could be, the voice of depression; in the vortex of my 
severest pain I had begun to develop that ancient voice myself. I 
never saw Romain again. 

Claude Gallimard, Franchise's father, had recollected to me how, in 
1980, only a few hours after another lunch where the talk between the 
two old friends had been composed and casual, even lighthearted, 
certainly anything but somber, Remain Gary- -twice winner of the Prix 
Goncourt (one of these awards pseudonymous, the result of his having 
gleefully tricked the critics), hero of the Republic, valorous recipient 
of the Croix de Guerre, diplomat, bon vivant, womanizer par excellence-went 
home to his apartment on the rue du Bac and put a bullet through his 
brain . 

It was at some point during the course of these musings that the sign 
hotel Washington swam across my vision, bringing back memories of my 
long-ago arrival | in the city, along with the fierce and sudden 
realization that I would never see Paris again. This certitude 
astonished me and filled me with a new fright, for while thoughts of 

death had long been common during my siege, blowing through my mind 
like icy gusts of wind, they were the formless shapes of doom that I 
suppose are dreamed of by people in the grip of any severe 
affliction . 

The difference now was in the sure understanding that tomorrow, when 
the pain descended once more, or the tomorrow after that--certainly on 
some not-too distant tomorrow--l would be forced to judge that life was 
not worth living and thereby answer, for myself at least, the 
fundamental question of philosophy. 


MANY OF Us WHO KNEW ABBIE HOFFMAN EVEN slightly, as I did, his death in 
the spring of 1989 was a sorrowful happening. Just past the age of fifty, 
he had been too young and apparently too vital for such an ending; a feeling 
of chagrin and dreadfulness attends the news of nearly anyone's suicide, 
and Abbie's death seemed to me especially cruel. I had first met him during 
the wild days and nights of the 1968 Democratic Convention in Chicago, 
where I had gone to write a piece for The New York Review of Books, and 
I later was one of those who testified in behalf of him and his fellow 
defendants at the trial, also in Chicago, in 1970. Amid the pious 
follies and morbid perversions of American life, his antic style was 
exhilarating, and it was hard not to admire the hell-raising and the 
brio, the anarchic individualism. I wish I had seen more of him in 
recent years; his sudden death left me with a particular emptiness, as 
suicides usually do to everyone. But the event was given a further dimension 
of poignancy by what one must begin to regard as a predictable reaction 
from many: the denial, the refusal to accept the fact of the suicide itself, 
as if the voluntary act--as opposed to an accident, or death from natural 
causes- -were tinged with a delinquency that somehow lessened the man 
and his character. 

Abbie's brother appeared on television, grief -ravaged and distraught; 
one could not help feeling compassion as he sought to deflect the idea 
of suicide, insisting that Abbie, after all, had always been careless 
with pills and would never have left his family bereft. However, the 

coroner confirmed that Hoffman had taken the equivalent of 150 
phenobarbitals. It's quite natural that the people closest to suicide 
victims so frequently and feverishly hasten to disclaim the truth; the 
sense of implication, of personal guilt- -the idea that one might have 
prevented the act if one had taken certain precautions, had somehow 
behaved differently--is perhaps inevitable. Even so, the 
sufferer- -whether he has actually killed himself or attempted to do so, 
or merely expressed threats--is often, through denial on the part of 
others, unjustly made to appear a wrongdoer. 

A similar case is that of Randall Jarrell--one of the fine poets and 
critics of his generation--who on a night in 1965, near Chapel Hill, North 
Carolina, was struck by a car and killed. Jarrell's presence on that 
particular stretch of road, at an odd hour of the evening, was puzzling, 
and since some of the indications were that he had deliberately let the 
car strike him, the early conclusion was that his death was suicide. 
Newsweek, among other publications, said as much, but Jarrell's widow 
protested in a letter to that magazine; there was a hue and cry from many 
of his friends and supporters, and a coroner's jury eventually ruled the 
death to be accidental. Jarrell had been suffering from extreme depression 
and had been hospitalized; only a few months before his misadventure on 
the highway and while in the hospital, he had slashed his wrists. 

Anyone who is acquainted with some of the jagged contours of Jarrell's 
life- -including his violent fluctuations of mood, his fits of black 
despondency- -and who, in addition, has acquired a basic knowledge of 
the danger signals of depression, would seriously question the verdict 
of the coroner's jury. But the stigma of self-inflicted death is for 
some people a hateful blot that demands erasure at all costs. (More 
than two decades after his death, in the Summer 1986 issue of The 
American Scholar, a one time student of Jarrell's, reviewing a 
collection of the poet's letters, made the review less a literary or 
biographical appraisal than an occasion for continuing to try to exorcise 
the vile phantom of suicide.) 

Randall Jarrell almost certainly killed himself. He did so not because 
he was a coward, nor out of any moral feebleness, but because he was 
afflicted with a depression that was so devastating that he could no 

longer endure the pain of it. 

This general unawareness of what depression is really like was apparent 
most recently in the matter of Primo Levi, the remarkable Italian 
writer and survivor of Auschwitz who, at the age of sixty-seven, hurled 
himself down a stairwell in Turin in 1987. Since my own involvement 
with the illness, I had been more than ordinarily interested in Levi's 
death, and so, late in 1988, when I read an account in The New York 
Times about a symposium on the writer and his work held at New York 
University, I was fascinated but, finally, appalled. For, according to 
the article, many of the participants, worldly writers and scholars, 
seemed mystified by Levi's suicide, mystified and disappointed. 

It was as if this man whom they had all so greatly admired, and who had 
endured so much at the hands of the Nazis- -a man of exemplary 
resilience and courage- -had by his suicide demonstrated a frailty, a 
crumbling of character they were loath to accept. In the face of a 
terrible absolute--selfdestruction--their reaction was helplessness and 
(the reader could not avoid it) a touch of shame. 

My annoyance over all this was so intense that I was prompted to write 
a short piece for the op-ed page of the Times. The argument I put 
forth was fairly straightforward: the pain of severe depression is quite 
unimaginable to those who have not suffered it, and it kills in many instances 
because its anguish can no longer be borne. The prevention of many suicides 
will continue to be hindered until there is a general awareness of the nature 
of this pain. Through the healing process of time--and through medical 
intervention or hospitalization in many cases- -most people survive 
depression, which may be its only blessing; but to the tragic legion 
who are compelled to destroy themselves there should be no more reproof 
attached than to the victims of terminal cancer. 

I had set down my thoughts in this Times piece rather hurriedly and 
spontaneously, but the response was equally spontaneous- -and enormous. 
It had taken, I speculated, no particular originality or boldness on my 
part to speak out frankly about suicide and the impulse toward it, but 
I had apparently underestimated the number of people for whom the subject 
had been taboo, a matter of secrecy and shame. The overwhelming reaction 

made me feel that inadvertently I had helped unlock a closet from which 
many souls were eager to come out and proclaim that they, too, had experienced 
the feelings I had described. It is the only time in my life I have felt 
it worthwhile to have invaded my own privacy, and to make that privacy 
public. And I thought that, given such momentum, and with my 
experience in Paris as a detailed example of what occurs during 
depression, it would be useful to try to chronicle some of my own 
experiences with the illness and in the process perhaps establish a 
frame of reference out of which one or more valuable conclusions might 
be drawn. Such conclusions, it has to be emphasized, must still be 
based on the events that happened to one man. In setting these 
reflections down I don't intend my ordeal to stand as a representation 
of what happens, or might happen, to others. Depression is much too 
complex in its cause, its symptoms and its treatment for unqualified 
conclusions to be drawn from the experience of a single individual. 
Although as an illness depression manifests certain unvarying 
characteristics, it also allows for many idiosyncrasies; I've been 
amazed at some of the freakish phenomena-not reported by other 
patients- -that it has wrought amid the twistings of my mind's labyrinth. 

Depression afflicts millions directly, and millions more who are 
relatives or friends of victims. It has been estimated that as many as 
one in ten Americans will suffer from the illness. As assertively 
democratic as a Norman Rockwell poster, it strikes indiscriminately at 
all ages, races, creeds and classes, though women are at considerably 
higher risk than men. The occupational list (dressmakers, barge 
captains, sushi chefs, cabinet members) of its patients is too long and 
tedious to give here; it is enough to say that very few people escape 
being a potential victim of the disease, at least in its milder form. 
Despite depression's eclectic reach, it has been demonstrated with fair 
convincing ness that artistic types (especially poets) are particularly 
vulnerable to the disorder--which, in its graver, clinical 
manifestation takes upward of twenty percent of its victims by way of 
suicide. Just a few of these fallen artists, all modern, make up a sad 
but scintillant roll call: Hart Crane, Vincent van Gogh, Virginia 
Woolf, Arshile Gorky, Cesare Pavese, Remain Gary, Vachel Lindsay, 
Sylvia Plath, Henry de Montherlant, Mark Rothko, John Berryman, Jack 
London, Ernest Hemingway, William Inge, Diane Arbus, Tadeusz Borowski, 

Paul Celan, Anne Sexton, Sergei Esenin, Vladimir Maya- kovsky-- the list goes 
on. (The Russian poet Maya-kovsky was harshly critical of his great 
contemporary Esenin' s suicide a few years before, which should stand as 
a caveat for all who are judgmental about self destruction.) When one 
thinks of these doomed and splendidly creative men and women, one is 
drawn to contemplate their childhoods, where, to the best of anyone's 
knowledge, the seeds of the illness take strong root; could any of them 
have had a hint, then, of the psyche's perish ability its exquisite 
fragility? And why were they destroyed, while others- -similarly 
stricken-struggled through? 


When I was first aware that i had been laid low by the disease, I felt 
a need, among other things, to register a strong protest against the 
word "depression." 

Depression, most people know, used to be termed "melancholia," a word 
which appears in English as early as the year 1303 and crops up more than 
once in Chaucer, who in his usage seemed to be aware of its pathological 

"Melancholia" would still appear to be a far more apt and evocative 
word for the blacker forms of the disorder, but it was usurped by a 
noun with a bland tonality and lacking any magisterial presence, used 
indifferently to describe an economic decline or a rut in the ground, a 
true wimp of a word for such a major illness. It may be that the 
scientist generally held responsible for its currency in modern times, 
a Johns Hopkins Medical School faculty member justly venerated--the 
Swiss-born psychiatrist Adolf Meyer- -had a tin ear for the finer 
rhythms of English and therefore was unaware of the semantic damage he 
had inflicted by offering "depression" as a descriptive noun for such a 
dreadful and raging disease. Nonetheless, for over seventy-five years 
the word has slithered innocuously through the language like a slug, 
leaving little trace of its intrinsic malevolence and preventing, by 
its very insipidity, a general awareness of the horrible intensity of 
the disease when out of control. 

As one who has suffered from the malady in extremis yet returned to 
tell the tale, I would lobby for a truly arresting designation. 

"Brainstorm, " for instance, has unfortunately been preempted to 
describe, somewhat jocularly, intellectual inspiration. But something 
along these lines is needed. Told that someone's mood disorder has evolved 
into a storm- -a veritable howling tempest in the brain, which is indeed 
what a clinical depression resembles like nothing else-even the 
uninformed layman might display sympathy rather than the standard 
reaction that "depression" evokes, something akin to "So what?" or 
"You'll pull out of it" or "We all have bad days." The phrase "nervous 
breakdown" seems to be on its way out, certainly deservedly so, owing 
to its insinuation of a vague spinelessness, but we still seem destined 
to be saddled with "depression" until a better, sturdier name is 
created . 

The depression that engulfed me was not of the manic type- -the one 
accompanied by euphoric highs- -which would have most probably presented 
itself earlier in my life. I was sixty when the illness struck for the 
first time, in the "unipolar" form, which leads straight down. I shall 
never learn what "caused" my depression, as no one will ever learn 
about their own. To be able to do so will likely forever prove to be 
an impossibility, so complex are the intermingled factors of abnormal 
chemistry, behavior and genetics. 

Plainly, multiple components are involved- -perhaps three or four, most 
probably more, in fathomless permutations. 

That is why the greatest fallacy about suicide lies in the belief that 
there is a single immediate answer- -or perhaps combined answers- -as to 
why the deed was done. 

The inevitable question "Why did he or she] do it?" usually leads to 
odd speculations, for the most part fallacies themselves. Reasons were 
quickly advanced for Abbie Hoffman's death: his reaction to an auto 
accident he had suffered, the failure of his most recent book, his 
mother's serious illness. With Randall Jarrell it was a declining 

career cruelly epitomized by a vicious book review and his consequent 
anguish. Primo Levi, it was rumored, had been burdened by caring for 
his paralytic mother, which was more onerous to his spirit than even 
his experience at Auschwitz. Any one of these factors may have lodged 
like a thorn in the sides of the three men, and been a torment. Such 
aggravations may be crucial and cannot be ignored. 

But most people quietly endure the equivalent of injuries, declining 
careers, nasty book reviews, family illnesses. A vast majority of the 
survivors of Auschwitz have borne up fairly well. Bloody and bowed by 
the outrages of life, most human beings still stagger on down the road, 
unscathed by real depression. To discover why some people plunge into 
the downward spiral of depression, one must search beyond the manifest 
crisis--and then still fail to come up with anything beyond wise conjecture. 

The storm which swept me into a hospital in December began as a cloud 
no bigger than a wine goblet the previous June. And the cloud--the 
manifest crisis- -involved alcohol, a substance I had been abusing for 
forty years. Like a great many American writers, whose sometimes 
lethal addiction to alcohol has become so legendary as to provide in 
itself a stream of studies and books, I used alcohol as the magical 
conduit to fantasy and euphoria, and to the enhancement of the 
imagination. There is no need to either rue or apologize for my use of 
this soothing, often sublime agent, which had contributed greatly to my 
writing; although I never set down a line while under its influence, I did 
use it--often in conjunction with music--as a means to let my mind conceive 
visions that the unaltered, sober brain has no access to. Alcohol was 
an invaluable senior partner of my intellect, besides being a friend 
whose ministrations I sought daily- -sought also, I now see, as a means 
to calm the anxiety and incipient dread that I had hidden away for so 
long somewhere in the dungeons of my spirit. 

The trouble was, at the beginning of this particular summer, that I was 
betrayed. It struck me quite suddenly, almost overnight: I could no longer 
drink. It was as if my body had risen up in protest, along with my mind, 
and had conspired to reject this daily mood bath which it had so long welcomed 
and, who knows? Perhaps even come to need. Many drinkers have experienced 
this intolerance as they have grown older. I suspect that the crisis was 

at least partly metabolic-the liver rebelling, as if to say, "No more, no 
more"-but at any rate I discovered that alcohol in minuscule amounts, 
even a mouthful of wine, caused me nausea, a desperate and unpleasant 
wooziness, a sinking sensation and ultimately a distinct revulsion. The 
comforting friend had abandoned me not gradually and reluctantly, as a 
true friend might do, but like a shot-and I was left high and certainly 
dry, and unhelmed. 

Neither by will nor by choice had I became an abstainer; the situation was 
puzzling to me, but it was also traumatic, and I date the onset of my 
depressive mood from the beginning of this deprivation . Logically, one would 
be overjoyed that the body had so summarily dismissed a substance that was 
undermining its health; it was as if my system had generated a form of Antabuse, 
which should have allowed me to happily go my way, satisfied that a trick 
of nature had shut me off from a harmful dependence. But, instead, I began 
to experience a vaguely troubling malaise, a sense of something having 
gone cockeyed in the domestic universe I'd dwelt in so long, so 

While depression is by no means unknown when people stop drinking, it 
is usually on a scale that is not menacing. But it should be kept in 
mind how idiosyncratic the faces of depression can be. 

It was not really alarming at first, since the change was subtle, but I 
did notice that my surroundings took on a different tone at certain 
times: the shadows of nightfall seemed more somber, my mornings were 
less buoyant, walks in the woods became less zestful, and there was a 
moment during my working hours in the late afternoon when a kind of 
panic and anxiety overtook me, just for a few minutes, accompanied by a 
visceral queasiness--such a seizure was at least slightly alarming, 
after all. As I set down these recollections, I realize that it should 
have been plain to me that I was already in the grip of the beginning 
of a mood disorder, but I was ignorant of such a condition at that 

When I reflected on this curious alteration of my consciousness --and I 
was baffled enough from time to time to do so- -I assumed that it all 
had to do somehow with my enforced withdrawal from alcohol. And, of 

course, to a certain extent this was true. But it is my conviction now that 
alcohol played a perverse trick on me when we said farewell to each 
other; although, as everyone should know, it is a major depressant, it 
had never truly depressed me during my drinking career, acting instead 
as a shield against anxiety. Suddenly vanished, the great ally which 
for so long had kept my demons at bay was no longer there to prevent 
those demons from beginning to swarm through the subconscious, and I 
was emotionally naked, vulnerable as I had never been before. 

Doubtless depression had hovered near me for years, waiting to swoop 
down. Now I was in the first stage- -premonitory, like a flicker of 
sheet lightning barely perceived- -of depression's black tempest. 

I was on Martha's Vineyard, where I've spent a good part of each year 
since the 1960s, during that exceptionally beautiful summer. But I had 
begun to respond indifferently to the island's pleasures. I felt a 
kind of numbness, an enervation, but more particularly an odd 
fragility- -as if my body had actually become frail, hypersensitive and 
somehow disjointed and clumsy, lacking normal coordination. And soon I 
was in the throes of a pervasive hypochondria. Nothing felt quite 
right with my corporeal self; there were twitches and pains, sometimes 
intermittent, often seemingly constant, that seemed to presage all sorts 
of dire infirmities. 

(Given these signs, one can understand how, as far back as the 
seventeenth century--in the notes of contemporary physicians, and in 
the perceptions of John Dryden and others- -a connection is made between 
melancholia and hypochondria; the words are often interchangeable, and 
were so used until the nineteenth century by writers as various as Sir 
Walter Scott and the Brontes, who also linked melancholy to a 
preoccupation with bodily ills.) It is easy to see how this condition 
is part of the psyche's apparatus of defense: unwilling to accept its 
own gathering deterioration, the mind announces to its indwelling 
consciousness that it is the body with its perhaps correctable 
defects--not the precious and irreplaceable mind--that is going 

In my case, the overall effect was immensely disturbing, augmenting the 

anxiety that was by now never quite absent from my waking hours and 
fueling still another strange behavior pattern--a fidgety restlessness 
that kept me on the move, somewhat to the perplexity of my family and 
friends. Once, in late summer, on an airplane trip to New York, I made 
the reckless mistake of downing a scotch and soda- -my first alcohol in 
months--which promptly sent me into a tailspin, causing me such a 
horrified sense of disease and interior doom that the very next day I rushed 
to a Manhattan internist, who inaugurated a long series of tests. Normally 
I would have been satisfied, indeed elated, when, after three weeks of 
high-tech and extremely expensive evaluation, the doctor pronounced me 
totally fit; and I was happy, for a day or two, until there once again 
began the rhythmic daily erosion of my mood- -anxiety, agitation, 
unfocused dread. 

By now I had moved back to my house in Connecticut. 

It was October, and one of the unforgettable features of this stage of 
my disorder was the way in which my old farmhouse, my beloved home for 
thirty years, took on for me at that point when my spirits regularly 
sank to their nadir an almost palpable quality of ominousness. The 
fading evening light- -akin to that famous "slant of light" of Emily 
Dickinson's, which spoke to her of death, of chill extinction--had none 
of its familiar autumnal loveliness, but ensnared me in a suffocating 
gloom. I wondered how this friendly place, teeming with such memories 
of (again in her words) "Lads and Girls," of "laughter and ability and 
Sighing, And Frocks and Curls," could almost perceptibly seem so 
hostile and forbidding. 

Physically, I was not alone. As always Rose was present and listened 
with unflagging patience to my complaints. 

But I felt an immense and aching solitude. I could no longer 
concentrate during those afternoon hours, which for years had been my 
working time, and the act of writing itself, becoming more and more 
difficult and exhausting, stalled, then finally ceased. 

There were also dreadful, pouncing seizures of anxiety. 

One bright day on a walk through the woods with my dog I heard a flock 
of Canada geese honking high above trees ablaze with foliage; 
ordinarily a sight and sound that would have exhilarated me, the flight 
of birds caused me to stop, riveted with fear, and I stood stranded 
there, helpless, shivering, aware for the first time that I had been 
stricken by no mere pangs of withdrawal but by a serious illness whose 
name and actuality I was able finally to acknowledge. Going home, I 
couldn't rid my mind of the line of Baudelaire's, dredged up from the 
distant past, that for several days had been skittering around at the 
edge of my consciousness: "I have felt the wind of the wing of 
madness. " 

Our perhaps understandable modern need to dull the sawtooth edges of so 
many of the afflictions we are heir to has led us to banish the harsh 
old-fashioned words; madhouse, asylum, insanity, melancholia, lunatic, 
madness. But never let it be doubted that depression, in its extreme form, 
is madness. The madness results from an aberrant biochemical process. It 
has been established with reasonable certainty (after strong resistance 
from many psychiatrists, and not all that long ago) that such madness is 
chemically induced amid the neurotransmitters of the brain, probably as 
the result of systemic stress, which for unknown reasons causes a depletion 
of the chemicals norepinephrine and serotonin, and the increase of a hormone, 

With all of this upheaval in the brain tissues, the alternate drenching 
and deprivation, it is no wonder that the mind begins to feel 
aggrieved, stricken, and the muddied thought processes register the 
distress of an organ in convulsion. Sometimes, though not very often, 
such a disturbed mind will turn to violent thoughts regarding others. 
But with their minds turned agonizingly inward, people with depression 
are usually dangerous only to themselves. The madness of depression 
is, generally speaking, the antithesis of violence. 

It is a storm indeed, but a storm of murk. Soon evident are the 
slowed-down responses, near paralysis, psychic energy throttled back 
close to zero. Ultimately, the body is affected and feels sapped, 
drained . 

That fall, as the disorder gradually took full possession of my system, 
I began to conceive that my mind itself was like one of those outmoded 
small- town telephone exchanges, being gradually inundated by floodwaters: 
one by one, the normal circuits began to drown, causing some of the 
functions of the body and nearly all of those of instinct and intellect 
to slowly disconnect. 

There is a well-known checklist of some of these functions and their 
failures. Mine conked out fairly close to schedule, many of them 
following the pattern of depressive seizures. I particularly remember 
the lamentable near disappearance of my voice. It underwent a strange 
transformation, becoming at times quite faint, wheezy and spasmodic- -a 
friend observed later that it was the voice of a ninety-year-old. The 
libido also made an early exit, as it does in most major illnesses- -it 
is the superfluous need of a body in beleaguered emergency. Many 
people lose all appetite; mine was relatively normal, but I found myself 
eating only for subsistence: food, like everything else within the scope 
of sensation, was utterly without savor. Most distressing of all the 
instinctual disruptions was that of sleep, along with a complete absence 
of dreams. 

Exhaustion combined with sleeplessness is a rare torture. The two or 
three hours of sleep I was able to get at night were always at the 
behest of the Halcion-a matter which deserves particular notice. For 
some time now many experts in psycho pharmacology have warned that the 
benzodiazepine family of tranquilizers, of which Halcion is one (Valium 
and Ativan are others), is capable of depressing mood and even 
precipitating a major depression. Over two years before my siege, an 
insouciant doctor had prescribed Ativan as a bedtime aid, telling me 
airily that I could take it as casually as aspirin. The Physicians' 
Desk Reference, the pharmacological bible, reveals that the medicine I 
had been ingesting was (a) three times the normally prescribed 
strength, (b) not advisable as a medication for more than a month or 
so, and (c) to be used with special caution by people of my age. At 
the time of which I am speaking I was no longer taking Ativan but had 
become addicted to Halcion and was consuming large doses. It seems 
reasonable to think that this was still another contributory factor to 

the trouble that had come upon me. Certainly, it should be a caution 
to others. 

At any rate, my few hours of sleep were usually terminated at three or 
four in the morning, when I stared up into yawning darkness, wondering 
and writhing at the devastation taking place in my mind, and awaiting 
the dawn, which usually permitted me a feverish, dreamless nap. I'm 
fairly certain that it was during one of these insomniac trances that there 
came over me the knowledge- -a weird and shocking revelation, like that of 
some long-be shrouded metaphysical truth--that this condition would cost 
me my life if it continued on such a course. This must have been just before 
my trip to Paris. Death, as I have said, was now a daily presence, 
blowing over me in cold gusts. I had not conceived precisely how my 
end would come. In short, I was still keeping the idea of suicide at 
bay. But plainly the possibility was around the corner, and I would 
soon meet it face to face. 

What I had begun to discover is that, mysteriously and in ways that are 
totally remote from normal experience, the gray drizzle of horror 
induced by depression takes on the quality of physical pain. But it is 
not an immediately identifiable pain, like that of a broken limb. It 
may be more accurate to say that despair, owing to some evil trick 
played upon the sick brain by the inhabiting psyche, comes to resemble 
the diabolical discomfort of being imprisoned in a fiercely overheated 
room. And because no breeze stirs this caldron, because there is no 
escape from this smothering confinement, it is entirely natural that 
the victim begins to think ceaselessly of oblivion. 


SAME OF THE MEMORABLE MOMENTS IN MADAME Bovary is the scene where the heroine 
seeks help from the village priest. Guilt-ridden, distraught, miserably 
depressed, the adulterous Emma- -heading toward eventual 
suicide- -stumblingly tries to prod the abbe into helping her find a way 
out of her misery. But the priest, a simple soul and none too bright, can 
only pluck at his stained cassock, distractedly shout at his acolytes, and 
offer Christian platitudes. Emma goes on her quietly frantic way, beyond 

comfort of God or man. 

I felt a bit like Emma Bovary in my relationship with the psychiatrist 
I shall call Dr. Gold, whom I began to visit immediately after my 
return from Paris, when the despair had commenced its merciless daily 
drumming. I had never before consulted a mental therapist for 
anything, and I felt awkward, also a bit defensive; my pain had become so 
intense that I considered it quite improbable that conversation with 
another mortal, even one with professional expertise in mood 
disorders, could alleviate the distress. Madame Bovary went to the 
priest with the same hesitant doubt. Yet our society is so structured 
that Dr. Gold, or someone like him, is the authority to whom one is 
forced to turn in crisis, and it is not entirely a bad idea, since Dr. 
Gold- -Yale- trained, highly qualified- -at least provides a focal point 
toward which one can direct one's dying energies, offers consolation if 
not much hope, and becomes the receptacle for an outpouring of woes 
during fifty minutes that also provides relief for the victim's wife. 
Still, while I would never question the potential efficacy of 
psychotherapy in the beginning manifestations or milder forms of the 
illness--or possibly even in the aftermath of a serious onslaught-its 
usefulness at the advanced stage I was in has to be virtually nil. My 
more specific purpose in consulting Dr. Gold was to obtain help 
through pharmacology-though this too was, alas, a chimera for a 
bottomed out victim such as I had become. 

He asked me if I was suicidal, and I reluctantly told him yes. I did 
not particularize--since there seemed no need to--did not tell him that 
in truth many of the artifacts of my house had become potential devices 
for my own destruction: the attic rafters (and an outside maple or two) 
a means to hang myself, the garage a place to inhale carbon monoxide, the 
bathtub a vessel to receive the flow from my opened arteries. The kitchen 
knives in their drawers had but one purpose for me. Death by heart attack 
seemed particularly inviting, absolving me as it would of active 
responsibility, and I had toyed with the idea of self-induced pneumonia 
--a long, frigid, shirt-sleeved hike through the rainy woods. Nor had I 
overlooked an ostensible accident, a la Randall Jarrell, by walking in front 
of a truck on the highway nearby. These thoughts may seem outlandishly 
macabre--a strained joke--but they are genuine. They are doubtless 

especially repugnant to healthy Americans, with their faith in self 
improvement. Yet in truth such hideous fantasies, which cause well people 
to shudder, are to the deeply depressed mind what lascivious daydreams are 
to persons of robust sexuality. Dr. Gold and I began to chat twice weekly, 
but there was little I could tell him except to try, vainly, to describe 
my desolation. 

Nor could he say much of value to me. His platitudes were not 
Christian but, almost as ineffective, dicta drawn straight from the 
pages of The Diagnostic and Statistical Manual of the American 
Psychiatric Association (much of which, as I mentioned earlier, I'd 
already read), and the solace he offered me was an antidepressant 
medication called Ludiomil. The pill made me edgy, disagreeably 
hyperactive, and when the dosage was increased after ten days, it 
blocked my bladder for hours one night. Upon informing Dr. Gold of 
this problem, I was told that ten more days must pass for the drug to 
clear my system before starting anew with a different pill. Ten days 
to someone stretched on such a torture rack is like ten centuries-and 
this does not begin to take into account the fact that when a new pill 
is inaugurated several weeks must pass before it becomes effective, a 
development which is far from guaranteed in any case. 

This brings up the matter of medication in general. 

Psychiatry must be given due credit for its continuing struggle to 
treat depression pharmacologic ally The use of lithium to stabilize 
moods in manic depression is a great medical achievement; the same drug 
is also being employed effectively as a preventive in many instances of 
unipolar depression. There can be no doubt that in certain moderate 
cases and some chronic forms of the disease (the so-called endogenous 
depressions) medications have proved invaluable, often altering the 
course of a serious disturbance dramatically. For reasons that are 
still not clear to me, neither medications nor psychotherapy were able to 
arrest my plunge toward the depths . If the claims of responsible authorities 
in the field can be believed- -including assertions made by physicians I've 
come to know personally and to respect- -the malign progress of my illness 
placed me in a distinct minority of patients, severely stricken, whose 
affliction is beyond control. In any case, I don't want to appear 

insensitive to the successful treatment ultimately enjoyed by most victims 
of depression. Especially in its earlier stages, the disease yields 
favorably to such techniques as cognitive therapy- -alone, or in 
combination with medications- -and other continually evolving 
psychiatric strategies. Most patients, after all, do not need to be 
hospitalized and do not attempt or actually commit suicide. But until 
that day when a swiftly acting agent is developed, one's faith in a 
pharmacological cure for major depression must remain provisional. The 
failure of these pills to act positively and quickly- -a defect which is 
now the general case-is somewhat analogous to the failure of nearly all 
drugs to stem massive bacterial infections in the years before 
antibiotics became a specific remedy. And it can be just as 

So I found little of worth to anticipate in my consultations with Dr. 
Gold . On my visits he and I continued to exchange platitudes, mine haltingly 
spoken now- -since my speech, emulating my way of walking, had slowed to 
the vocal equivalent of a shuffle--and I'm sure as tiresome as his. 

Despite the still-faltering methods of treatment, psychiatry has, on an 
analytical and philosophical level, contributed a lot to an 
understanding of the origins of depression. Much obviously remains to 
be learned (and a great deal will doubtless continue to be a mystery, 
owing to the disease's idiopathic nature, its constant interchange 
ability of factors), but certainly one psychological element has been 
established beyond reasonable doubt, and that is the concept of loss. 
Loss in all of its manifestations is the touchstone of depression--in 
the progress of the disease and, most likely, in its origin. At a 
later date I would gradually be persuaded that devastating loss in 
childhood figured as a probable genesis of my own disorder; meanwhile, 
as I monitored my retrograde condition, I felt loss at every hand. The 
loss of self-esteem is a celebrated symptom, and my own sense of self 
had all but disappeared, along with any self-reliance. This loss can 
quickly degenerate into dependence, and from dependence into infantile 
dread. One dreads the loss of all things, all people close and dear. 
There is an acute fear of abandonment. Being alone in the house, even for 
a moment, caused me exquisite panic and trepidation. 

Of the images recollected from that time the most bizarre and 
discomfiting remains the one of me, age four and a half, tagging 
through a market after my long-suffering wife; not for an instant could 
I let out of my sight the endlessly patient soul who had become nanny, 
mommy, comforter, priestess, and, most important, confidante--a 
counselor of rocklike centrality to my existence whose wisdom far 
exceeded that of Dr. Gold. I would hazard the opinion that many 
disastrous sequels to depression might be averted if the victims 
received support such as she gave me. But meanwhile my losses mounted 
and proliferated. There is no doubt that as one nears the penultimate 
depths of depression-which is to say just before the stage when one 
begins to act out one's suicide instead of being a mere contemplator of 
it- -the acute sense of loss is connected with a knowledge of life 
slipping away at accelerated speed. One develops fierce attachments. 
Ludicrous things--my reading glasses, a handkerchief, a certain writing 
instrument- -became the objects of my demented possessiveness. Each 
momentary misplacement filled me with a frenzied dismay, each item 
being the tactile reminder of a world soon to be obliterated. 

November wore on, bleak, raw and chill. One Sunday a photographer and 
his assistants came to take pictures for an article to be published in 
a national magazine. Of the session I can recall little except the 
first snowflakes of winter dotting the air outside. I thought I obeyed 
the photographer's request to smile often. A day or two later the 
magazine's editor telephoned my wife, asking if I would submit to 
another session. The reason he advanced was that the pictures of me, 
even the ones with smiles, were "too full of anguish." 

I had now reached that phase of the disorder where all sense of hope 
had vanished, along with the idea of a futurity; my brain, in thrall to 
its outlaw hormones, had become less an organ of thought than an 
instrument registering, minute by minute, varying degrees of its own 
suffering. The mornings themselves were becoming bad now as I wandered 
about lethargic, following my synthetic sleep, but afternoons were 
still the worst, beginning at about three o'clock, when I'd feel the 
horror, like some poisonous fog bank roll in upon my mind, forcing me 
into bed. There I would lie for as long as six hours, stuporous and 

virtually paralyzed, gazing at the ceiling and waiting for that moment 
of evening when, mysteriously, the crucifixion would ease up just enough 
to allow me to force down some food and then, like an automaton, seek an 
hour or two of sleep again. Why wasn't I in a hospital? 



erratic and haphazardly written-whose contents I would not have particularly 
liked to be scrutinized by eyes other than my own. I had hidden it well 
out of sight in my house. I imply no scandalous ness the observations were 
far less raunchy, or wicked, or self -revealing, than my desire to keep the 
notebook private might indicate. Nonetheless, the small volume was one that 
I fully intended to make use of professionally and then destroy before the 
distant day when the specter of the nursing home came too near. So as 
my illness worsened I rather queasily realized that if I once decided 
to get rid of the notebook that moment would necessarily coincide with 
my decision to put an end to myself. And one evening during early 
December this moment came. 

That afternoon I had been driven (I could no longer drive) to Dr. 
Gold's office, where he announced that he had decided to place me on 
the antidepressant Nardil, an older medication which had the advantage 
of not causing the urinary retention of the other two pills he had 
prescribed. However, there were drawbacks. 

Nardil would probably not take effect in less than four to six weeks- -I 
could scarcely believe this- -and I would have to carefully obey certain 
dietary restrictions, fortunately rather epicurean (no sausage, no 
cheese, no pate de foie gras), in order to avoid a clash of 
incompatible enzymes that might cause a stroke. 

Further, Dr. Gold said with a straight face, the pill at optimum 
dosage could have the side effect of impotence. 

Until that moment, although I'd had some trouble with his personality, 
I had not thought him totally lacking in perspicacity; now I was not at 

all sure. 

Putting myself in Dr. Gold's shoes, I wondered if he seriously thought 
that this juiceless and ravaged semi invalid with the shuffle and the 
ancient wheeze woke up each morning from his Halcion sleep eager for 
carnal fun. 

There was a quality so comfortless about that day's session that I went 
home in a particularly wretched state and prepared for the evening. A 
few guests were coming over for dinner- -something which I neither dreaded 
nor welcomed and which in itself (that is, in my torpid indifference) reveals 
a fascinating aspect of depression's pathology. This concerns not the 
familiar threshold of pain but a parallel phenomenon, and that is the 
probable inability of the psyche to absorb pain beyond predictable 
limits of time. There is a region in the experience of pain where the 
certainty of alleviation often permits superhuman endurance. We learn 
to live with pain in varying degrees daily, or over longer periods of 
time, and we are more often than not mercifully free of it. When we 
endure severe discomfort of a physical nature our conditioning has 
taught us since childhood to make accommodations to the pain's 
demands- -to accept it, whether pluckily or whimpering and complaining, 
according to our personal degree of stoicism, but in any case to accept 
it. Except in intractable terminal pain, there is almost always some 
form of relief; we look forward to that alleviation, whether it be 
through sleep or Tylenol or self -hypnosis or a change of posture or, 
most often, through the body's capacity for healing itself, and we 
embrace this eventual respite as the natural reward we receive for 
having been, temporarily, such good sports and doughty sufferers, such 
optimistic cheerleaders for life at heart. 

In depression this faith in deliverance, in ultimate restoration, is 
absent. The pain is unrelenting, and what makes the condition 
intolerable is the foreknowledge that no remedy will come- -not in a 
day, an hour, a month, or a minute. If there is mild relief, one knows 
that it is only temporary; more pain will follow. 

It is hopelessness even more than pain that crushes the soul. So the 

decision -making of daily life involves not, as in normal affairs, 
shifting from one annoying situation to another less annoying--or from 
discomfort to relative comfort, or from boredom to activity- -but moving 
from pain to pain. One does not abandon, even briefly, one's bed of 
nails, but is attached to it wherever one goes. And this results in a 
striking experience- -one which I have called, borrowing military 
terminology, the situation of the walking wounded. For in virtually 
any other serious sickness, a patient who felt similar devastation 
would be lying flat in bed, possibly sedated and hooked up to the tubes 
and wires of life-support systems, but at the very least in a posture 
of repose and in an isolated setting. His invalidism would be 
necessary, unquestioned and honorably attained. However, the sufferer 
from depression has no such option and therefore finds himself, like a 
walking casualty of war, thrust into the most intolerable social and family 
situations. There he must, despite the anguish devouring his brain, present 
a face approximating the one that is associated with ordinary events and 
companionship. He must try to utter small talk, and be responsive to 
questions, and knowingly nod and frown and, God help him, even smile. But 
it is a fierce trial attempting to speak a few simple words. 

That December evening, for example, I could have remained in bed as 
usual during those worst hours, or agreed to the dinner party my wife 
had arranged downstairs. But the very idea of a decision was 

Either course was torture, and I chose the dinner not out of any 
particular merit but through indifference to what I knew would be 
indistinguishable ordeals of fogbound horror. At dinner I was barely 
able to speak, but the quartet of guests, who were all good friends, 
were aware of my condition and politely ignored my catatonic muteness. 
Then, after dinner, sitting in the living room, I experienced a curious 
inner convulsion that I can describe only as despair beyond despair. It 
came out of the cold night; I did not think such anguish possible. 

While my friends quietly chatted in front of the fire I excused myself 
and went upstairs, where I retrieved my notebook from its special 
place. Then I went to the kitchen and with gleaming clarity--the clarity 
of one who knows he is engaged in a solemn rite- -I noted all the trademarked 

legends on the well-advertised articles which I began assembling for the 
volume's disposal: the new roll of Viva paper towels I opened to wrap up 
the book, the Scotch-brand tape I encircled it with, the empty Post Raisin 
Bran box I put the parcel into before taking it outside and stuffing it 
deep down within the garbage can, which would be emptied the next morning. 
Fire would have destroyed it faster, but in garbage there was an 
annihilation of self appropriate, as always, to melancholia's fecund 
self humiliation. I felt my heart pounding wildly, like that of a man 
facing a firing squad, and knew I had made an irreversible decision. 

A phenomenon that a number of people have noted while in deep 
depression is the sense of being accompanied by a second self- -a 
wraithlike observer who, not sharing the dementia of his double, is 
able to watch with dispassionate curiosity as his companion struggles 
against the oncoming disaster, or decides to embrace it. 

There is a theatrical quality about all this, and during the next 
several days, as I went about stolidly preparing for extinction, I 
couldn't shake off a sense of melodrama- -a melodrama in which I, the 
victim-to-be of self-murder, was both the solitary actor and lone member 
of the audience. I had not as yet chosen the mode of my departure, but I 
knew that that step would come next, and soon, as inescapable as 

I watched myself in mingled terror and fascination as I began to make 
the necessary preparation: going to see my lawyer in the nearby 
town--there rewriting my will--and spending part of a couple of 
afternoons in a muddled attempt to bestow upon posterity a letter of 
farewell. It turned out that putting together a suicide note, which I 
felt obsessed with a necessity to compose, was the most difficult task 
of writing that I had ever tackled. There were too many people to 
acknowledge, to thank, to bequeath final bouquets. And finally I 
couldn't manage the sheer dirge like solemnity of it; there was 
something I found almost comically offensive in the pomposity of such a 
comment as "For some time now I have sensed in my work a growing 
psychosis that is doubtless a reflection of the psychotic strain 
tainting my life" (this is one of the few lines I recall verbatim), as 
well as something degrading in the prospect of a testament, which I 

wished to infuse with at least some dignity and eloquence, reduced to 
an exhausted stutter of inadequate apologies and self serving 
explanations. I should have used as an example the mordant statement of 
the Italian writer Cesare Pavese, who in parting wrote simply: No more words . 

An act, I'll never write again. 

But even a few words came to seem to me too long winded and I tore up 
all my efforts, resolving to go out in silence. Late one bitterly cold 
night, when I knew that I could not possibly get myself through the 
following day, I sat in the living room of the house bundled up against 
the chill; something had happened to the furnace. My wife had gone to 
bed, and I had forced myself to watch the tape of a movie in which a 
young actress, who had been in a play of mine, was cast in a small 
part. At one point in the film, which was set in 

late-nineteenth-century Boston, the characters moved down the hallway 
of a music conservatory, beyond the walls of which, from unseen 
musicians, came a contralto voice, a sudden soaring passage from the 
Brahms Alto Rhapsody. 

This sound, which like all music- -indeed, like all pleasure- -I had been 
numbly unresponsive to for months, pierced my heart like a dagger, and 
in a flood of swift recollection I thought of all the joys the house 
had known: the children who had rushed through its rooms, the 
festivals, the love and work, the honestly earned slumber, the voices 
and the nimble commotion, the perennial tribe of cats and dogs and birds, 
"laughter and ability and Sighing, And Frocks and Curls." All this I 
realized was more than I could ever abandon, even as what I had set out 
so deliberately to do was more than I could inflict on those memories, and 
upon those, so close to me, with whom the memories were bound. And just 
as powerfully I realized I could not commit this desecration on myself. 
I drew upon some last gleam of sanity to perceive the terrifying dimensions 
of the mortal predicament I had fallen into. I woke up my wife and soon 
telephone calls were made. The next day I was admitted to the 


IT WAS DR GOLD, ACTING AS MY ATTENDING PHYSIcian, who was called in to 
arrange for my hospital admission. Curiously enough, it was he who 
told me once or twice during our sessions (and after I had rather 
hesitantly broached the possibility of hospitalization) that I should 
try to avoid the hospital at all costs, owing to the stigma I might suffer. 
Such a comment seemed then, as it does now, extremely misguided; I had thought 
psychiatry had advanced long beyond the point where stigma was attached 
to any aspect of mental illness, including the hospital. This refuge, while 
hardly an enjoyable place, is a facility where patients still may go when 
pills fail, as they did in my case, and where one ' s treatment might be regarded 
as a prolonged extension, in a different setting, of the therapy that begins 
in offices such as Dr. Gold's. 

It's impossible to say, of course, what another doctor's approach might 
have been, whether he too might have discouraged the hospital route. 
Many psychiatrists, who simply do not seem to be able to comprehend the 
nature and depth of the anguish their patients are undergoing, maintain 
their stubborn allegiance to pharmaceuticals in the belief that 
eventually the pills will kick in, the patient will respond, and the 
somber surroundings of the hospital will be avoided. Dr. Gold was 
such a type, it seems clear, but in my case he was wrong; I'm convinced 
I should have been in the hospital weeks before. For, in fact, the 
hospital was my salvation, and it is something of a paradox that in 
this austere place with its locked and wired doors and desolate green 
hallways- -ambulances screeching night and day ten floors below- -I found 
the repose, the assuagement of the tempest in my brain, that I was unable 
to find in my quiet farmhouse. 

This is partly the result of sequestration, of safety, of being removed 
to a world in which the urge to pick up a knife and plunge it into 
one's own breast disappears in the newfound knowledge, quickly apparent 
even to the depressive's fuzzy brain, that the knife with which he is 
attempting to cut his dreadful Swiss steak is bendable plastic. But 
the hospital also offers the mild, oddly gratifying trauma of sudden 
stabilization-- a transfer out of the too familiar surroundings of 
home, where all is anxiety and discord, into an orderly and benign 
detention where one's only duty is to try to get well. For me the real 
healers were seclusion and time. 



When I entered the place, my depression appeared so profound that, in the 
opinion of some of the staff, I was a candidate for ECT, electro convulsive 
therapy-shock treatment, as it is better known. In many cases this is an 
effective remedy- -it has undergone improvement and has made a respectable 
comeback, generally shedding the medieval disrepute into which it was once 
cast- -but it is plainly a drastic procedure one would want to avoid. I 
avoided it because I began to get well, gradually but steadily. I was amazed 
to discover that the fantasies of self-destruction all but disappeared 
within a few days after I checked in, and this again is testimony to the 
pacifying effect that the hospital can create, its immediate value as a 
sanctuary where peace can return to the mind. 

A final cautionary word, however, should be added concerning Halcion. 
I'm convinced that this tranquilizer is responsible for at least 
exaggerating to an intolerable point the suicidal ideas that had 
possessed me before entering the hospital. The empirical evidence that 
persuades me of this evolves from a conversation I had with a staff 
psychiatrist only hours after going into the institution. When he 
asked me what I was taking for sleep, and the dosage, I told him .75 mg 
of Halcion; at this his face became somber, and he remarked emphatically 
that this was three times the normally prescribed hypnotic dose, and an 
amount especially contraindicated for someone my age. I was switched 
immediately to Dalmane, another hypnotic which is a somewhat longer-acting 
cousin, and this proved at least as effective as Halcion in putting me to 
sleep; but most importantly, I noticed that soon after the switch my suicidal 
notions dwindled then disappeared. 

Much evidence has accumulated recently that indicts Halcion (whose 
chemical name is triazolam) as a causative factor in producing suicidal 
obsession and other aberrations of thought in susceptible 

Because of such reactions Halcion has been categorically banned in the 

Netherlands, and it should be at least more carefully monitored here. I 
don't recall Dr. Gold once questioning the overly hefty dose which he 
knew I was taking; he presumably had not read the warning data in the 
Physicians' Desk Reference, While my own carelessness was at fault in 
ingesting such an overdose, I ascribe such carelessness to the bland 
assurance given me several years before, when I began to take Ativan at 
the behest of the breezy doctor who told me that I could, without harm, 
take as many of the pills as I wished. One cringes when thinking about 
the damage such promiscuous prescribing of these potentially dangerous 
tranquilizers may be creating in patients everywhere. In my case Halcion, 
of course, was not an independent villain- -I was headed for the abyss- -but 
I believe that without it I might not have been brought so low. 

I stayed in the hospital for nearly seven weeks. Not everyone might 
respond the way I did; depression, one must constantly insist, presents 
so many variations and has so many subtle facets- -depends, in short, so 
much on the individual's totality of causation and response-that one 
person's panacea might be another's trap. But certainly the hospital 
(and, of course, I am speaking of the many good ones) should be shorn 
of its menacing reputation, should not so often be considered the 
method of treatment of last resort. The hospital is hardly a vacation 
spot; the one in which I was lodged (I was privileged to be in one of 
the nation's best) possessed every hospital's stupefying dreariness. If 
in addition there are assembled on one floor, as on mine, fourteen or 
fifteen middle-aged males and females in the throes of melancholia of a 
suicidal complexion, then one can assume a fairly laughter less 
environment . 

This was not ameliorated for me by the sub airline food or by the peek 
I had into the outside world: Dynasty and Knots Landing and the CBS 
Evening News un spooling nightly in the bare recreation room, 
sometimes making me at least aware that the place where I had found refuge 
was a kinder, gentler madhouse than the one I'd left. In the hospital I 
partook of what may be depression's only grudging favor- -its ultimate 
capitulation . 

Even those for whom any kind of therapy is a futile exercise can look 
forward to the eventual passing of the storm. If they survive the 

storm itself, its fury almost always fades and then disappears. 
Mysterious in its coming, mysterious in its going, the affliction runs 
its course, and one finds peace. 

As I got better I found distraction of sorts in the hospital's routine, 
with its own institutionalized sitcoms. 

Group Therapy, I am told, has some value; I would never want to 
derogate any concept shown to be effective for certain individuals. But 
Group Therapy did nothing for me except make me seethe, possibly 
because it was supervised by an odiously smug young shrink, with a 
spade-shaped dark beard (der junge Freud?), who in attempting to get us 
to cough up the seeds of our misery was alternately condescending and 
bullying, and occasionally reduced one or two of the women patients, so 
forlorn in their kimonos and curlers, to what I'm certain he regarded 
as satisfactory tears. (I thought the rest of the psychiatric staff 
exemplary in their tact and compassion.) Time hangs heavy in the hospital, 
and the best I can say for Group Therapy is that it was a way to occupy 
the hours. 

More or less the same can be said for Art Therapy, which is organized 
infantilism. Our class was run by a delirious young woman with a 
fixed, indefatigable smile, who was plainly trained at a school 
offering courses in Teaching Art to the Mentally ill; not even a 
teacher of very young retarded children could have been compelled to 
bestow, without deliberate instruction, such orchestrated chuckles and 
coos. Unwinding long rolls of slippery mural paper, she would tell us 
to take our crayons and make drawings illustrative of themes that we 
ourselves had chosen. For example: My House. In humiliated rage I 
obeyed, drawing a square, with a door and four cross-eyed windows, a 
chimney on top issuing forth a curlicue of smoke. She showered me with 
praise, and as the weeks advanced and my health improved so did my 
sense of comedy. I began to dabble happily in colored modeling clay, 
sculpting at first a horrid little green skull with bared teeth, which 
our teacher pronounced a splendid replica of my depression. 

I then proceeded through intermediate stages of recuperation to a rosy 
and cherubic head with a "Have-a-Nice-Day" smile. Coinciding as it did 

with the time of my release, this creation truly overjoyed my instructress 
(whom I'd become fond of in spite of myself), since, as she told me, it 
was emblematic of my recovery and therefore but one more example of the 
triumph over disease by Art Therapy. 

By this time it was early February, and although I was still shaky I 
knew I had emerged into light. I felt myself no longer a husk but a 
body with some of the body's sweet juices stirring again. I had my 
first dream in many months, confused but to this day imperishable, with 
a flute in it somewhere, and a wild goose, and a dancing girl. 


By FAR THE GREAT MAJORITY OF THE PEOPLE WHO go through even the severest 
depression survive it, and live ever afterward at least as happily as their 
un afflicted counterparts. Save for the awfulness of certain memories it 
leaves, acute depression inflicts few permanent wounds. There is a 
Sisyphean torment in the fact that a great number- -as many as half- -of those 
who are devastated once will be struck again; depression has the habit 
of recurrence. But most victims live through even these relapses, 
often coping better because they have become psychologically tuned by 
past experience to deal with the ogre. It is of great importance that 
those who are suffering a siege, perhaps for the first time, be 
told--be convinced, rather--that the illness will run its course and 
that they will pull through. A tough job, this; calling "Chin up!" 
from the safety of the shore to a drowning person is tantamount to 
insult, but it has been shown over and over again that if the 
encouragement is dogged enough-and the support equally committed and 
passionate-the endangered one can nearly always be saved. Most people 
in the grip of depression at its ghastliest are, for whatever reason, 
in a state of unrealistic hopelessness, torn by exaggerated ills and 
fatal threats that bear no resemblance to actuality. It may require on 
the part of friends, lovers, family, admirers, an almost religious 
devotion to persuade the sufferers of life's worth, which is so often 
in conflict with a sense of their own worthlessness, but such devotion 
has prevented countless suicides. 

During the same summer of my decline, a close friend of mine- -a 

celebrated newspaper columnist was hospitalized for severe manic 
depression. By the time I had commenced my autumnal plunge my friend 
had recovered (largely due to lithium but also to psychotherapy in the 
aftermath), and we were in touch by telephone nearly every day. His 
support was untiring and priceless. It was he who kept admonishing me 
that suicide was "unacceptable" (he had been intensely suicidal), and 
it was also he who made the prospect of going to the hospital less 
fearsomely intimidating. I still look back on his concern with immense 

The help he gave me, he later said, had been a continuing therapy for 
him, thus demonstrating that, if nothing else, the disease engenders 
lasting fellowship. 

After I began to recover in the hospital it occurred to me to 
wonder- -for the first time with any really serious concern- -why I had 
been visited by such a calamity. The psychiatric literature on 
depression is enormous, with theory after theory concerning the 
disease's etiology proliferating as richly as theories about the death 
of the dinosaurs or the origin of black holes. 

The very number of hypotheses is testimony to the malady's all but 
impenetrable mystery. As for that initial triggering mechanism- -what I 
have called the manifest crisis- -can I really be satisfied with the 
idea that abrupt withdrawal from alcohol started the plunge downward? What 
about other possibilities — the dour fact, for instance, that at about the 
same time I was smitten I turned sixty, that hulking milestone of mortality? 

Or could it be that a vague dissatisfaction with the way in which my 
work was going- -the onset of inertia which has possessed me time and 
time again during my writing life, and made me crabbed and 
discontented--had also haunted me more fiercely during that period than 
ever, somehow magnifying the difficulty with alcohol? Unresolvable 
questions, perhaps. 

These matters in any case interest me less than the search for earlier 
origins of the disease. What are the forgotten or buried events that 

suggest an ultimate explanation for the evolution of depression and its 
later flowering into madness? Until the onslaught of my own illness 
and its denouement, I never gave much thought to my work in terms of 
its connection with the subconscious--an area of investigation 
belonging to literary detectives. But after I had returned to health 
and was able to reflect on the past in the light of my ordeal, I began 
to see clearly how depression had clung close to the outer edges of my 
life for many years. 

Suicide has been a persistent theme in my books-three of my major 
characters killed themselves. In rereading, for the first time in 
years, sequences from my novels- -passages where my heroines have lurched 
down pathways toward doom- -I was stunned to perceive how accurately I had 
created the landscape of depression in the minds of these young women, 
describing with what could only be instinct, out of a subconscious already 
roiled by disturbances of mood, the psychic imbalance that led them to 
destruction . 

Thus depression, when it finally came to me, was in fact no stranger, 
not even a visitor totally unannounced; it had been tapping at my door for 

The morbid condition proceeded, I have come to believe, from my 
beginning years--from my father, who battled the gorgon for much of his 
lifetime, and had been hospitalized in my boyhood after a despondent 
spiraling downward that in retrospect I saw greatly resembled mine. The 
genetic roots of depression seem now to be beyond controversy. But I'm 
persuaded that an even more significant factor was the death of my 
mother when I was thirteen; this disorder and early sorrow--the death 
or disappearance of a parent, especially a mother, before or during 
puberty-appears repeatedly in the literature on depression as a trauma 
sometimes likely to create nearly irreparable emotional havoc. The 
danger is especially apparent if the young person is affected by what 
has been termed "incomplete mourning"- -has, in effect, been unable to 
achieve the catharsis of grief, and so carries within himself through later 
years an insufferable burden of which rage and guilt, and not only dammed-up 
sorrow, are a part, and become the potential seeds of self-destruction. 

In an illuminating new book on suicide, Self Destruction in the 
Promised Land, Howard I. Kushner, who is not a psychiatrist but a 
social historian, argues persuasively in favor of this theory of 
incomplete mourning and uses Abraham Lincoln as an example. 

While Lincoln's hectic moods of melancholy are legend, it is much less 
well known that in his youth he was often in a suicidal turmoil and 
came close more than once to making an attempt on his own life. The 
behavior seems directly linked to the death of Lincoln's mother, Nancy 
Hanks, when he was nine, and to unexpressed grief exacerbated by his 
sister's death ten years later. Drawing insights from the chronicle of 
Lincoln's painful success in avoiding suicide, Kushner makes a 
convincing case not only for the idea of early loss precipitating 
self -destructive conduct, but also, auspiciously, for that same 
behavior becoming a strategy through which the person involved comes to 
grips with his guilt and rage, and triumphs over self-willed death. Such 
reconciliation may be entwined with the quest for immortality- -in Lincoln's 
case, no less than that of a writer of fiction, to vanquish death through 
work honored by posterity. 

So if this theory of incomplete mourning has validity, and I think it 
does, and if it is also true that in the nethermost depths of one's 
suicidal behavior one is still subconsciously dealing with immense loss 
while trying to surmount all the effects of its devastation, then my 
own avoidance of death may have been belated homage to my mother. I do 
know that in those last hours before I rescued myself, when I listened 
to the passage from the Alto Rhapsody- -which I'd heard her sing-she had 
been very much on my mind. 


Hear the end of an early film of ingmar berg man's, Through a Glass 
Darkly, a young woman, experiencing the embrace of what appears to be 
profound psychotic depression, has a terrifying hallucination. 

Anticipating the arrival of some transcendental and saving glimpse of God, 
she sees instead the quivering shape of a monstrous spider that is attempting 
to violate her sexually. It is an instant of horror and scalding truth. 

Yet even in this vision of Bergman (who has suffered cruelly from depression) 
there is a sense that all of his accomplished artistry has somehow fallen 
short of a true rendition of the drowned mind's appalling phantasmagoria. 
Since antiquity--in the tortured lament of Job, in the choruses of Sophocles 
and Aeschylus- -chroniclers of the human spirit have been wrestling with 
a vocabulary that might give proper expression to the desolation of 
melancholia. Through the course of literature and art the theme of 
depression has run like a durable thread of woe- -from Hamlet's 
soliloquy to the verses of Emily Dickinson and Gerard Manley Hopkins, 
from John Donne to Hawthorne and Dostoevski and Poe, Camus and Conrad 
and Virginia Woolf. In many of Albrecht Diner's engravings there are 
harrowing depictions of his own melancholia; the manic wheeling stars 
of Van Gogh are the precursors of the artist's plunge into dementia and 
the extinction of self. It is a suffering that often tinges the music 
of Beethoven, of Schumann and Mahler, and permeates the darker cantatas 
of Bach. The vast metaphor which most faithfully represents this 
fathomless ordeal, how ever, is that of Dante, and his all-too-familiar 
lines still arrest the imagination with their augury of the unknowable, 
the black struggle to come: 

Nel mezzo del cam ming di nostra vita Mi ritrovat per una sel va 
oscura, Che la diritta via era smamta. 

In the middle of the journey of our life I found myself in a dark wood, 
For I had lost the right path. 

One can be sure that these words have been more than once employed to 
conjure the ravages of melancholia, but their somber foreboding has 
often overshadowed the last lines of the best-known part of that poem, 
with their evocation of hope. To most of those who have experienced 
it, the horror of depression is so overwhelming as to be quite beyond 
expression, hence the frustrated sense of inadequacy found in the work 
of even the greatest artists. But in science and art the search will 
doubtless go on for a clear representation of its meaning, which 
sometimes, for those who have known it, is a simulacrum of all the evil 
of our world: of our everyday discord and chaos, our irrationality, warfare 
and crime, torture and violence, our impulse toward death and our flight 
from it held in the intolerable equipoise of history. If our lives had no 

other configuration but this, we should want, and perhaps deserve, to perish; 
if depression had no termination, then suicide would, indeed, be the only 
remedy. But one need not sound the false or inspirational note to stress 
the truth that depression is not the soul's annihilation; men and women 
who have recovered from the disease- -and they are countless- -bear witness 
to what is probably its only saving grace: it is conquerable. 

For those who have dwelt in depression's dark wood, and known its 
inexplicable agony, their return from the abyss is not unlike the 
ascent of the poet, trudging upward and upward out of hell's black 
depths and at last emerging into what he saw as "the shining world." 

There, whoever has been restored to health has almost always been 
restored to the capacity for serenity and joy, and this may be 
indemnity enough for having endured the despair beyond despair. 

E quindi. uscimmo a riveder le stelle. 

And so we came forth, and once again beheld the stars. 


william styron is the author of Lie Down in Darkness, The Long March, 
Set This House on Fire, The Confessions of Nat Turner, Sophie's Choice, 
and This Quiet Dust. He has been awarded the Pulitzer Prize, the 
American Book Award, the Howells Medal, and the Edward MacDowell 

He lives in Roxbury, Connecticut, and Vineyard Haven, Massachusetts.